Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | 292142 | CA |
NPI | 1114460409 |
---|---|
Provider Name | Marie Boo |
First Address | Palo Alto, CA 94306-4498 |
Second Address | Stanford, CA 94305-6106 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2016 |
Last Update Date | 18/11/2016 |